“Going into this, I expected to find it did make sense to wait until there was a limited amount of liver disease, but what we found to our surprise is that it makes sense to start treatment at the earliest change in the liver,” said senior author Dr. James Kahn, of the University of California, San Francisco.
Hepatitis C virus (HCV) is spread by blood. For most people, the infection becomes chronic, and about 20 percent of HCV infections result in liver damage, according to the U.S. Department of Veterans Affairs. Liver damage from HCV can lead to liver cancer or liver failure severe enough to warrant a liver transplant.
Over 3 million people in the U.S. have chronic hepatitis C, the researchers write in JAMA Internal Medicine.
Older drugs to fight hepatitis C required almost a year of treatment, had harsh side effects and didn’t always work. A new class of drugs cuts treatment time to 12 weeks or less and works in most people with the virus, but cost about $1,000 per day, they add.
While other studies found the new drugs to be cost effective, the new study looked at whether that’s true at each stage of liver damage. Some insurers won’t let patients take the drugs until their liver disease is advanced.
The researchers created a simulated model to study the cost-effectiveness of a medicine that contains the drugs sofosbuvir and ledipasvir and is sold by Gilead as Harvoni.
Other expensive new drugs for HCV include Sovaldi, which costs $84,000 for a 12-week course of treatment, and Viekira Pak, which costs about $83,000 for 12 weeks.
The imaginary subjects were 1,000 patients with HCV, of varying ages and with various stages of liver damage.
The researchers found that using Harvoni to treat people with any evidence of liver damage from HCV, compared to giving it only to people with more severe disease, added about one year of healthy life for less than $50,000, which is considered highly cost effective.
Results were similar for other new treatments for HCV, the researchers write.
While treating all stages of liver disease was cost-effective, the up-front cost is substantial. Treating half of those with hepatitis C would cost about $53 billion. That cost can be brought down if the price of the drug also decreases, the researchers write.
“I think a key policy point here is that cost-effectiveness is important and this study shows that, but a next and important step is . . . to address the cost of the drug,” said lead author Harinder Chahal, also of the University of California, San Francisco.
The recent focus on drug prices at the U.S. Department of Health and Human Services and in Congress is positive, he said.
Aside from price, there are other challenges to delivering treatment to all those infected with hepatitis C, wrote Dr. Hal Yee Jr. in an editorial.
“The paper is nice, because it provides us with evidence that it’s cost effective to treat people early, but it’s not efficient if you don’t have the resources to treat people early,” said Yee, who is affiliated with the Los Angeles County Department of Health Services in California.
For example, he writes in his editorial, people may have trouble finding doctors who can manage their HCV treatment.
“I think we need to think rationally about how to provide the care and reduce disparities of care,” he told.